Wed Jun 14 2023

Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with suspected infection in the emergency department: a prospective cohort study

Early identification of patients at risk of clinical deterioration may improve the prognosis of infected patients in the emergency department (ED). suPAR combined with clinical scoring might result in a more accurate mortality prediction than a clinical scoring system or biomarker alone.

Background: Identifying patients at risk of developing sepsis early in the emergency department is essential. These patients require hospital admission and more intensive monitoring or treatment. On the other hand, patients with mild infections may be discharged early from the ED, saving time and resources.

suPARPhysicians determine the severity of the disease by clinical assessment with the addition of vital signs and laboratory parameters. This clinical assessment relies on the physician’s experience, making it subjective to the individual physician and may vary between different physicians. Therefore, clinical scoring systems have been developed to predict disease severity objectively. Two commonly used clinical scoring systems are the National Early Warning Score-2 (NEWS2) and quick Sequential Organ Failure Assessment (qSOFA) score. A general biomarker of disease severity is the soluble urokinase plasminogen activator receptor (suPAR). suPAR is a protein expressed on endothelial and immune cells, and its levels are associated with immune activation. Therefore, suPAR levels are predictive of disease severity in a general ED population, regardless of the reason of ED visit. Combining clinical scoring systems with biomarkers may result in a more accurate mortality prediction than a clinical scoring system or biomarker alone.

This study investigates the performance of the combination of NEWS2 and qSOFA score with suPAR and procalcitonin on risk stratification on 30-day mortality in patients with suspected infection in the ED.

Methods: The FORESEEN study was conducted in the ED of Erasmus University Medical Center, an academic hospital with 40 000 ED visits yearly. The FORESEEN study was conducted between 15 March 2019 and 27 November 2020. A total of 2325 patients were screened for eligibility, of which 958 were included in the FORESEEN study.

Conclusion: In this prospective cohort study, a high level of suPAR and procalcitonin were significantly associated with an increased mortality risk compared to patients with either a low or high qSOFA and those with low NEWS2. It can be beneficial to combine suPAR with clinical scoring.

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